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Lymphoreticular neoplasms with myriad of specific diseases and cellular differentiation
Multiple types with variable imaging manifestations
Epidural lymphoma: Thoracic > lumbar > cervical
Enhancing epidural mass ± vertebral involvement
Osseous lymphoma: Long bones > spine
Bone destruction (“ivory” vertebra, rare), vertebra plana
Lymphomatous leptomeningitis
Smooth/nodular pial enhancement
Intramedullary lymphoma: Cervical > thoracic > lumbar
Poorly defined, enhancing mass
Secondary > primary involvement
Extradural > intradural > intramedullary
FDG PET useful for staging, monitoring treatment response, predicting treatment outcomes, and risk stratifying lymphoma patients
Lymphoma is most common malignancy of epidural space
Non-Hodgkin lymphoma (NHL) > > Hodgkin disease; 80-90% are B cell
CNS lymphoma > 85% NHL (B cell > > > T cell)
CNS lymphoma may be primary or secondary (hematogenous or direct geographic extension)
Most common presenting symptom = back pain
Intramedullary = myelopathy (weakness, numbness)
Cord compression occurs in up to 5-10% of systemic lymphomas
Generally poor prognosis for CNS lymphoma
Markedly sensitive to chemotherapy/XRT
Depressed humoral and cell-mediated immunity leads to opportunistic infections
Lymphoreticular neoplasms with a myriad of specific diseases and cellular differentiation
Location
Multiple types with variable imaging manifestations
Epidural lymphoma: Thoracic > lumbar > cervical
Epidural extension from adjacent vertebral/paraspinous disease
Osseous lymphoma: Long bones > spine
Lymphomatous leptomeningitis
Intramedullary lymphoma: Cervical > thoracic > lumbar
Secondary > primary involvement
30% of systemic lymphomas have skeletal involvement
Primary osseous lymphoma = 3-4% of all malignant bone tumors
Extradural > intradural > intramedullary
Best imaging clues
Epidural: Enhancing epidural mass ± vertebral involvement
Osseous: Bone destruction (“ivory” vertebra rare)
Leptomeningitic: Smooth/nodular pial enhancement
Intramedullary: Poorly defined enhancing mass
Angiotropic lymphoma (AL): Early signal intensity abnormalities
Radiography
Epidural: May see bony erosion
Osseous
Bone destruction (30-40%)
Rare “ivory” vertebral body, vertebra plana
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